Provider Demographics
NPI:1386898567
Name:BERNI, TRAVIS DON
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:DON
Last Name:BERNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E STE 220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6924
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:6360 S 3000 E STE 310
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:801-944-3144
Practice Address - Fax:801-944-3186
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331123-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered